Provider Demographics
NPI:1770191819
Name:CONRAD, ROBERT (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CONRAD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NEW LEICESTER HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1917
Mailing Address - Country:US
Mailing Address - Phone:828-225-3838
Mailing Address - Fax:
Practice Address - Street 1:4188 HIGHWAY 80 S # 10
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-9585
Practice Address - Country:US
Practice Address - Phone:828-225-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist